Wednesday, April 30, 2008

And the Treatment Plan?...Self-Cleaning It IS!

When the hand surgeon walked into the office, he held out his hand for me to shake it. I responded as I always do now: --I'm sorry, I don't shake hands any more.

This stops them in their tracks. Unfortunately, it also generally offends them. But I can't figure out how to say it in a nicer way.

He raised his eyebrows and left his hand in the air and said, --oooooKay. Why is that?

--Because I'm colonized with CA MRSA and I don't want to pass it to you. I'm also immunocompromised and don't want to pick up any germs.

--And who told you this?

Now it's my turn to be offended. It's an irritating question that could be put in a much nicer way on their part. I know they hate it when people *self-diagnose.* And I understand why. But good Lord, why ASSUME that's what I'm doing?!? Why not just say, --Okay, could you go through the history on that for me? That's a non-accusatory way to get the exact same response from the patient.

--Who told me? Well, lots of doctors, hospitals...The culture for this wound here came back positive for MRSA, it was cultured last Thursday. See this foot? (I flex Poor Mr. Foot.) The MRSA abscess in there was huge. They almost had to amputate. That was in 2004, and ever since then, I reinfect myself all the time. They culture the infections and they're MRSA. I scrub in Hibiclens, I did the Muciprin in the nose, I'm on permanent antibiotics, nothing helps. I can't seem to get rid of the germ.

--What's that bruising from? (My legs are all purple now.)

--Minocycline.

--Ah. Why are you on Minocycline?

--Uhhh...(WTF? I try not to sound like I'm talking to a two-year-old.) Because of the MRSA. And I'm immunocompromised, I get other germs too, they're hard to shake. My IgG is tanking now too.

By then he's reading the printed out Medical History I bring from home, and taking me seriously enough to put on some effing GLOVES. Finally.

This is particularly necessary because even though I washed in Hibiclens (microbe-killing surgical scrub soap) before I left home, the wound has cracked open and is draining again. I'm leaking germs on him. It made a nice little tunnel at one end of the wound.

Sounds like bad news? No! It's SUPERB news.

We want it to drain. We want all the germs out from under the skin before the wound seals shut and traps them inside, which can lead to making an abscess and further horrors.

If it drains on its own, it's self-cleaning.

See?

He looked at the wound and started poking around.

The pain is intense in the joints that connect the first two fingers to the hand, and down into the back of the hand.

--It doesn't look bad at all.

--Nope. Not any more. But it's still infected and still hurts like you would not believe. You should have seen it last week. It was gross. Draining MRSA pus non-stop, I'd mop it dry and it would pour out again.

--How do you know it was MRSA pus?

--Ummm...(WTF?!?!?) Because that's what they cultured. The stuff oozing out of the infected cut.

I no longer care if I sound like I'm talking to a two-year-old. I mean, come ON, how many times have I answered that by now?

He asks how I got the cut, when the infection set in, all that. Where it hurts. Why I'm on pain meds.

His attitude has changed, markedly.

Of all the many different kinds of doctors I see, the hand surgeons have the most wonderful office art, by far.

--Let's do some xrays, okay?

--Good. Thank you.

--But outside of that, I have to tell you, you need to go back to your ID doctor. He--

--She.

--Who?

--Dr. C.

--I don't know her. Out of what hospital?

--Holy Cross.

--Then if it does need surgery, she'll set it up inpatient there. The hand surgeons there will take care of it.

--But they aren't on my insurance plan.

--Doesn't matter. They're covered once you're in the hospital. And for a person with the complicated medical issues you have - The debridement itself my mother could do. (What? a joke? I'm shocked! He didn't seem to have it in him. I am gratified.) --But with you, it's really not the debridement that's the biggest issue. You have to get started on IV antibiotics and so forth, prepped, make sure you're supported against infection even before the debridement. The only proper way to do all that is usually inpatient. To start all over with a whole new medical team and put you in Broward General would be madness. Madness. Do you understand?

--Yes, I do. That makes sense. If I knew last Thursday what I know now, I probably wouldn't be here. But I was referred to a hand surgeon then on an urgent basis, and the ID doc was consulting on the phone with the dermatologist, so that's what I tried to do. Of the six hand surgeons on my plan, four refused to treat me. You weren't available until today. So here I am. And thank you for seeing me.

The dermatologist, with all the best intentions and sense, confused the issue by trying the (perfectly reasonable) approach of sending me straight to the proper surgeon.

Now I know better. And I called Walter and told him: --Next time I have any kind of infection issue, no matter what anyone says, make sure I go STRAIGHT to Dr. C, okay? I don't ever want to go through this kind of bullshit again. I mean, as horrible as it was to learn, now I know I'll get kicked to the curb by other doctors. I needed to know that. I just don't want to go through it again.

Check out this new xray developer. They put the plate in the top slot, and the xray pops out the bottom, like a photocopier.

The xrays seem clear. That means they checked to see if the infection had gotten into the bones - osteomyelitis, and a condition to be dreaded; it often means amputation. Unfortunately, as he said, osteomyelitis doesn't usually appear on xrays until it's pretty advanced.

And the fact that it's draining again is great. He said if he were to do the surgery himself, he'd probably wait at this point. (Meaning, we're going to see if it forms an abscess now.) --But try to keep it draining, keep it from closing. And keep it dressed, don't you dress it?!

--Sure, are you kidding? Of course. I live on Silvadene and Hibiclens. I only left it off so you could see it. I'll dress it again right now.

And the nice radiologist, who was sitting in at that point, offered me one of their bandaids as I got my Silvadene out of my purse. Yes, I don't leave home without it.

I have now gone in a big circle and arrived right back where I started. Sadder and wiser, and still with the threat of an abscess hanging over my head. But what I learned, this time, was of extraordinary importance.

I left a message for Dr. C, and now I'm going to decompress out in my yard..

Yes, he did the right thing. It was a song and dance I'm sure you're as well acquainted with as I am! And the difference with him was this: His attitude CHANGED. In other words, while it took a bit for the *cultures* info to sink in, it finally did. He realized I was on the level and why, and behaved accordingly.

So in the end, of course, I didn't mind at all. I prefer the song and dance to be unnecessary, but hey. That's life. The result, getting the right info? That's all I really care about in the end. The rest is sort of window dressing - usually.

Jan. Okay. You have a point. That was one of the biggest reasons I started all this in the first place. I see things out there that healthy people should know too, to stay as healthy as they can.

morris, hi! The funny thing? Things actually go my way a lot of the time. It's like the *good* points are many and strong, just like the *bad* ones can be. Extremes, on both ends of the scale. At least it's not boring!

Paypal Tip Jar

About Me

I'm a nice quiet middle-aged former bankbuster, disabled since age 32 with a myriad of weird health issues. I love heat and humidity and odd hobbies like fossil hunting, tromping around in the Everglades, backyard bricklaying, and rescuing plants damaged by our spate of hurricanes. Oh - I like to live-blog hurricanes, too.*****
I have a wonderful life. I'm one of the happiest people I know. Why? I don't know.*****
I also have nightmare memories in my head that would send some folks around the bend. But that's another story, one I don't tell much, and I seem to have made it past the horror parts pretty well.*****
I have nothing to prove so it's hard to insult me. I know who I am. I own the space I live in - and I don't mean just my house. My life is way far from perfect, but I'm content.*****
For some readers, that would make this a boring blog. For others, my fun adventures, absurd health episodes, and particular way of looking at things keep 'em entertained enough, in the end.